20 April 2006

Meningococcal Disease - update

As of 17 March 2006, outbreaks of meningococcal meningitis have occurred in 32 districts in seven countries in the African ‘meningitis belt’ [1].  Cases have occurred in two foci, one in West Africa affecting Burkina Faso, Côte d’Ivoire, Mali, and Niger caused predominantly by Neisseria meningitidis serogroup A.  The second focus has been in the east African countries of Kenya, Sudan, and Uganda caused mostly by N. meningitidis serogroup W135.  A total of 5,719 suspected cases, including 580 deaths, have been reported to the WHO [1].

Burkina Faso

Between 1 January and 5 March 2006, 3,636 suspected cases including 399 deaths (case fatality rate, CFR, 11%) were reported.  The epidemic threshold has been crossed in 12 districts.  All cases for which the aetiology can be determined (equivalent to 115 cerebral spinal fluid (CSF) samples taken) have been positive for N. meningitidis serogroup A [1].

Niger

Between 1 January and 26 February 2006, 614 cases and 44 deaths were reported.  The epidemic threshold has been crossed in two districts. More than 40 specimens of CSF have been positive for N. meningitidis serogroup A [2]

Kenya

From 1 January to 26 February 2006, 74 cases and 15 deaths (CFR 20%) were reported in four divisions (Alale, Chepareria, Kachelila, and Kasei) of West Pokot, an area bordering the epidemic districts of Uganda.  N. meningitidis serogroup W135 has been confirmed by laboratory culture [3].

Uganda

Between 9 January and 5 March 2006, 37 suspected cases including five deaths (CFR 14%) have been reported in Internally Displaced Persons (IDP) camps in Gulu district in the north west of the country.  Four cases were positive for N. meningitidis serogroup W135 [1].

Sudan

Between 1 January and 28 March 2006 outbreaks of meningococcal meningitis have been reported in 15 of the 25 states in Sudan.  A total of 1,335 cases were reported including 145 deaths (CFR 11%) [4]. Most cases have been caused by N. meningitidis serogroup A, however serogroup W135 has been confirmed in an outbreak among IDP in West Darfur.

In addition to these countries, outbreaks have been reported from Côte d’Ivoire, Guinea, and Mali.  It is expected that cases will continue to occur within countries of the African meningitis belt.

Major vaccinating campaigns are underway in countries experiencing outbreaks.  For more information on the coordination of the vaccination response, see the International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control at

http://www.who.int/csr/disease/meningococcal/icg/en.

Advice for travellers

The risk of meningococcal meningitis for tourists is low; the risk is higher for those travellers who will be living or working with local persons, especially during prolonged periods, in endemic areas.

Immunisation using the quadrivalent ACW135Y vaccine should be considered for [5]:

• travellers who will be living or working with local persons
• long stay and rural travellers visiting areas of risk
• travellers visiting an area of risk during an outbreak

A list of countries with potential risk in Africa can be found here

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References

1. World Health Organisation. Meningococcal disease in the African Meningitis Belt, epidemic season 2006. [cited 19 April 2006] Available at http://www.who.int/entity/csr/don/2006_03_21/en/index.html

2. World Health Organisation. Meningococcal disease in Niger. 3 March 2006. [cited 19 April 2006] Available at http://www.who.int/csr/don/2006_03_03/en/index.html

3. World Health Organisation. Meningococcal disease in Kenya. 3 March 2006. [cited 19 April 2006] Available at http://www.who.int/entity/csr/don/2006_03_03a/en/index.html

4. World Health Organisation. Update on meningitis in Sudan. 30 Mar 2006. [cited 19 April 2006] Available at

http://www.emro.who.int/sudan/media/pdf/Meningococcal meningitis in Sudan 30 March 061.pdf

5. NaTHNaC. Update: Changes to meningococcal meningitis recommendations for travellers. 21 July 2004. [cited 19 April 2006] Available at http://www.NaTHNaC.org/travel/news/

men_210704.htm

Links

NaTHNaC Meningococcal Meningitis Information Sheet: http://www.NaTHNaC.org/travel/factsheets/meningococcal.htm